Background: Fracture risk calculators (FRC) with DXA can guide osteoporosis (OP) management in the absence of dual X-ray absorptiometry (DXA). There is little information of the role of FRC without DXA. Objectives: Determine the accuracy of age-stratified Garvan FRC thresholds without DXA to manage OP. Methods: Cross-sectional study of 531 participants, ≥70 years old who underwent DXA and had Garvan FRC scores with and without DXA calculated. Age-stratified Garvan scores without DXA, generated low (no action), moderate (order DXA) or high (treat without DXA) risk thresholds of OP. Accuracy of our thresholds were assessed against DXA confirmed OP. Results: Age-specific GARVAN thresholds resulted in the correct decision in 85–88% of cases; “over-treated” OP in 7–8%; and, missed OP in 5–8%. 256 (48%) DXAs were unnecessary. Compared to recommended guidelines, Garvan HF and MOF thresholds improved accuracy of clinical decisions by 31% and 12%, respectively. Conclusions: Age-specific FRC score thresholds successfully identified who required treatment or DXA, with potential to reduce unnecessary DXA.